[Pharmacologic therapy of severe heart failure].
Improvement of symptoms and, accordingly, quality of life, as well as prolongation of life, are the objectives of drug therapy in congestive heart failure patients. Diuretics are most effective in relieving symptoms related to congestion, and angiotensin converting enzyme inhibitors improve exercise capacity, reduce the incidence of decompensations and hence hospitalizations, and prolong life. Angiotensin type-1 receptor antagonists also seem to improve survival, while digoxin improves symptoms and morbidity but not survival in patients in sinus rhythm. The value of prophylactic antiarrhythmic therapy with amiodarone and oral anticoagulation in the presence of sinus rhythm is not established, and the role of newer dihydropyridine calcium antagonists and betablockers is also not precisely defined. These agents should only be considered in selected cases after careful consideration of potential advantages and risks, and should usually be used as an addition to established therapy. Better understanding of the pathophysiology of congestive heart failure will lead to the development of new treatment concepts, the clinical relevance of which will have to be tested in appropriately designed clinical trials.
Kiowski
W
W
Abteilung Kardiologie, Universitätsspital, Zürich.
Sütsch
G
G
Fatio
R
R
Schalcher
C
C
Brunner-LaRocca
H P
HP
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000803:Angiotensin I / Q000378:metabolism; D057911:Angiotensin Receptor Antagonists; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D015507:Drugs, Investigational / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D002316:Cardiotonic Agents; D004232:Diuretics; D015507:Drugs, Investigational; D000803:Angiotensin I
Die medikamentöse Therapie der schweren Herzinsuffizienz.